Abnormally enhanced midfrontal theta activity during response monitoring in youths with obsessive-compulsive disorder
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Abstract
Background Response monitoring, as reflected in electroencephalogram recordings after commission of errors, has been consistently shown to be abnormally enhanced in individuals with obsessive-compulsive disorder (OCD). This has traditionally been quantified as error-related negativity (ERN) and may reflect abnormal neurophysiological mechanisms underlying OCD. However, the ERN reflects the increase in phase-locked activities, particularly in the theta-band (4-8 Hz), and does not reflect non-phase-locked activities. To more broadly investigate midfrontal theta activity in a brain region that is essential for complex cognition, this study investigated theta abnormalities during response monitoring in participants with OCD to acheive a better understanding of the mechanism underlying the ERN.Methods Electroencephalogram data were recorded from 99 participants with pediatric OCD and 99 sex- and age-matched healthy control participants while they completed the arrow flanker task. Effects of group (OCD, healthy control) and response type (error, correct) on postresponse theta total power and intertrial phase coherence (ITPC) were examined using mixed analysis of covariance and Bayesian analyses controlling for sex and accuracy.Results Theta total power was larger on error than on correct trials and larger in OCD than healthy control participants, but there was no effect of response type between groups. Theta ITPC was larger on error than correct trials, but there was no group difference or response type difference between the groups. Correlations of theta total power and ITPC with clinical measures were overall small.Conclusions Abnormally enhanced midfrontal theta total power, but not ITPC, may reflect ineffective heightened response monitoring or compensatory activity in pediatric OCD.
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In study [46], youth with OCD performed slightly less accurately than healthy controls on the flanker task, especially on incongruent trials, and also showed poorer Tower of London planning performance, with more total moves and fewer correctly solved problems.
“Youth with OCD performed slightly less accurately than healthy controls on the flanker task, especially on incongruent trials, and also showed poorer Tower of London planning performance, with more total moves and fewer correctly solved problems.”
From Electrophysiological Correlates of Cognitive Dysfunction in Obsessive-Compulsive Disorder (OCD): A Systematic and Mechanistic Review of EEG, ERP, and QEEG Evidence (2026) · cites this paper as [46]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIncreased ERN amplitude is an endophenotype of a predisposition to develop the pathology.
“confirming that increased ERN amplitude is an endophenotype of a predisposition to develop the pathology.”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [35]
The Introduction says enhanced ERN is associated with OCD and has characteristics of a potential endophenotype. The Discussion notes enhanced ERN in some unaffected family members, suggesting genetic predisposition. These passages support the proposed link, but they do not confirm that increased ERN amplitude is an established marker of predisposition to develop OCD. (LLM, conf=0.86)
Experimental — accuracy not yet measuredERN amplitude increases progressively with age in both pediatric OCD patients and age-matched controls.
“Furthermore, ERN amplitude increases progressively with age in both pediatric OCD patients and age‐matched controls [34, 35].”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [35]
The Introduction says ERN amplitude increases with age until around 18, and the Results report that older age was associated with larger ERP amplitude in a sample of pediatric OCD patients and age-matched controls. The Results do not establish a progressive increase in ERN amplitude separately in each group; the reported age association is for ERP amplitude across the analysis. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn most pediatric studies reviewed, only the amplitude of the ERN/CRN component was measured and statistically analyzed, but close examination of Pe/Pc tracings revealed that in most of them, the amplitude of the Pe component appeared substantially smaller in children with OCD than in control children or adolescents.
“In most cases, only the amplitude of the ERN/CRN component was measured and statistically analyzed. However, close examination of the Pe/Pc tracings obtained in these studies revealed that in most of them, the amplitude of the Pe component appeared to be substantially smaller in children with OCD than in control children or adolescents [25, 33–36, 64, 65].”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [35]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn a larger paediatric sample, OCD was associated with increased theta total power across response types, whereas theta phase consistency did not differ from controls.
“In a larger paediatric sample, OCD was associated with increased theta total power across response types, whereas theta phase consistency did not differ from controls [46].”
In study [46], theta phase coherence increased after errors in both groups but did not differ between OCD and control participants.
“By contrast, theta phase coherence increased after errors in both groups but did not differ between OCD and control participants.”
In study [46], youth with OCD showed elevated theta total power across response types.
“Importantly, youth with OCD showed elevated theta total power across response types.”
In study [46], theta-band total power was greater after errors than correct responses across participants, confirming the role of theta activity in response monitoring.
“EEG analysis showed that theta-band total power was greater after errors than correct responses across participants, confirming the role of theta activity in response monitoring.”
In study [46], exploratory associations between EEG measures and clinical or behavioural variables, including Tower of London performance, were small overall.
“Although the OCD group showed both elevated theta power and measurable cognitive-performance differences, exploratory associations between EEG measures and clinical or behavioural variables, including Tower of London performance, were small overall.”
In study [46], the group-by-response interaction was not significant.
“However, the group-by-response interaction was not significant”
As in adult OCD patients, children and adolescents with OCD show an increase in ERN amplitude compared to age-matched control participants.
“As in adult OCD patients, children and adolescents with OCD show an increase in ERN amplitude compared to age‐matched control participants.”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [35]
This increase is also seen in siblings not expressing the disease.
“This increase is also seen in siblings not expressing the disease [25, 33–35]”
From Error-Related Brain Potentials as Biomarkers of Pathology Severity and Treatment Resistance in Patients With Obsessive-Compulsive Disorder (2026) · cites this paper as [35]
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“This increase is also seen in siblings not expressing the disease [25, 33 – 35], con fi rming that increased ERN amplitude is an endophenotype of a predisposition to develop the pathology.”
Suzuki, T., Menkes, M. W., McInnis, M. G., Kang, J., Niendam, T., Walton, M. A., Deldin, P., Tso, I. F., & Taylor, S. F. (2025) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2025.100540
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Pre-war induced theta oscillations moderate adolescents’ psychological responses to war exposure
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Pang, Y., Zhou, D., Peng, Z., Liu, W., Huang, R., Seger, C. A., & Chen, Q. (2026) · PLoS Biology · doi:10.1371/journal.pbio.3003979
- Authors
- Suzuki, T., Gu, P., Grove, T. B., Hammond, T., Collins, K. M., Pamidighantam, P., Arnold, P. D., Taylor, S. F., Liu, Y., Gehring, W. J., Hanna, G. L., & Tso, I. F.
- Affiliations
- University of Michigan (US)
- University of Calgary (CA)
- Corresponding author
- Suzuki, Takakuni
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2023-06
- Volume
- 93
- Issue
- 11
- Pages
- 1031-1040
- ISSN
- 0006-3223
- PMC
- PMC10182182
- OpenAlex
- W4309047421
- Cited by
- 20
- References
- 70
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 2 · 2023: 3 · 2022: 2
- Type
- posted content
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Biological Psychiatry (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
- PsyArXiv (OSF Preprints) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (L30MH127715, R01MH085321, R01MH101493, R01MH122491)
- Boehringer Ingelheim
- National Center for Advancing Translational Sciences (KL2TR002241, UL1TR002240)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, pediatric OCD, response monitoring, error-related negativity, inter-trial phase coherence, error detection
- MeSH terms
- Adolescent, Bayes Theorem, Brain, Child, Cognition, Electroencephalography, Evoked Potentials, Female, Humans, Male, Obsessive-Compulsive Disorder, Theta Rhythm, Time Factors, Young Adult
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